<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Opt_date')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-opt_date" class="form-control datetimepicker" data-date-format="YYYY-MM-DD" data-use-current="true" name="row[opt_date]" type="text" value="{:date('Y-m-d')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lingqu')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-lingqu" class="form-control" name="row[lingqu]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Jieyu')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-jieyu" class="form-control" name="row[jieyu]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zhuo_ling')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-zhuo_ling" class="form-control" name="row[zhuo_ling]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zhuo_jiao')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-zhuo_jiao" class="form-control" name="row[zhuo_jiao]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Yi_ling')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-yi_ling" class="form-control" name="row[yi_ling]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Yi_jiao')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-yi_jiao" class="form-control" name="row[yi_jiao]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zhong_ling')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-zhong_ling" class="form-control" name="row[zhong_ling]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Wu_jiao')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-wu_jiao" class="form-control" name="row[wu_jiao]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Wu_ling')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-wu_ling" class="form-control" name="row[wu_ling]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shouli_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shouli_id" data-rule="required" data-source="shouli/index" class="form-control selectpage" name="row[shouli_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Remark')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-remark" class="form-control" name="row[remark]" type="text" value="">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
